Spine Journal最新文献

{"title":"Letter to the Editor regarding “Real world clinical outcomes when discontinuing denosumab or bisphosphonates in patients with surgically managed osteoporotic vertebral compression fractures: a population-based cohort study” by Huang et al","authors":"Yu Chang MD , Da-Wei Huang MD , Jung-Shun Lee MD, MSc","doi":"10.1016/j.spinee.2025.01.008","DOIUrl":"10.1016/j.spinee.2025.01.008","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Page 1077"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of fusion status in patients with minimum 1-year survival post-oncologic spinal fusion.","authors":"Seth Wilson, Jacob Ward, Anas Bardeesi, Santino Cua, Vicente de Paulo Martins Coelho, Mark Damante, Daniel Kreatsoulas, J Bradley Elder, Joshua Palmer, David Xu, Vikram Chakravarthy","doi":"10.1016/j.spinee.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.002","url":null,"abstract":"<p><strong>Background context: </strong>Oncologic patients have significant medical comorbidities which may impact arthrodesis after spine surgery. Furthermore, there is a paucity of published data describing fusion rates, and arthrodesis quality.</p><p><strong>Purpose: </strong>In this study, we present institutional data for patients with minimum 1-year survival who underwent spinal fusion secondary to treatment of metastatic spine disease.</p><p><strong>Study design/setting: </strong>Retrospective cohort study done at a single tertiary medical center.</p><p><strong>Patient sample: </strong>Patients were selected from a single institution between 2012 and 2022. Included patients had spinal fusion as part of oncologic treatment, minimum of 1 year follow up, and postoperative Computed Tomography (CT) scan at minimum 1 year.</p><p><strong>Outcome measures: </strong>Patient outcomes included fusion status and Hounsfield units (HU) on CT scan at 1 year.</p><p><strong>Methods: </strong>Retrospective chart review was performed collecting demographic and treatment information including postoperative oncologic and radiation treatment as well as HU along the cranial and caudal pedicles bilaterally on the 1-year CT scan. Indications for surgery included symptomatic metastatic disease. All surgeries were performed by 1 of 3 surgeons at a single tertiary medical center. Statistical analysis was performed using the Student T-Test and Chi-Squared Test.</p><p><strong>Results: </strong>There were 74 patients presenting with metastatic spine disease who met inclusion criteria. Demographics included an average age of 61.9 years at time of surgery, median construct length of 6 levels, and median survival was 43.2 months. Our cohort demonstrated complete and partial fusion rates of 11.1% and 59.5%, respectively. There was a significant difference in average HU for patients demonstrating fusion at 1 year, 444.2 compared to those demonstrating a lack of fusion, 285.8 (p<.0001). Patients who received postoperative radiation had higher postoperative HU than those who did not receive radiotherapy (411.1 vs. 304.9, p=.042). There was no significant difference in fusion status based on postoperative chemotherapy status, p=.127. Additionally, there was no difference in HU based on SBRT versus conventional radiotherapy, p=.588.</p><p><strong>Conclusion: </strong>Partial fusion was seen in over half of the study cohort at 1-year follow-up; complete fusion was seen in 11% of patients. Fused patients and those who received postoperative chemotherapy had significantly higher HU on 1-year CT. Maximizing control of cancer burden as well as improving bone quality may help patients with metastatic spine disease demonstrate bony fusion. More research is indicated to evaluate causal implications of survival in patients with metastatic spine disease that have undergone spinal fusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying the impact of spine-specific sarcopenia and generalized sarcopenia on clinical features in patients with lumbar degenerative diseases.","authors":"Tianshu Feng, Jinbo Zhao, Jinghang Li, Yaoyu Wang, Lianlei Wang, Xinyu Liu","doi":"10.1016/j.spinee.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The pathogenesis of paraspinal degeneration and sarcopenia, which is characterized by the decrease in generalized muscle quality and quantity, may be different in patients with lumbar degenerative diseases (LDD). In addition, the impact of them on the clinical features of LDD and their interaction are still unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the impact of generalized and spine-specific sarcopenia on the clinical features of patients with LDD and further examine the mediating role of paraspinal muscles STUDY DESIGN: A retrospective analysis of a prospective, nonrandomized cohort dataset.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 285 patients with LDD aged over 50 years were enrolled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Sarcopenia was defined when low appendicular muscle mass was present in combination with low muscle strength or low physical performance, and spine-specific sarcopenia was designated below the gender median value of the total rfCSA of the MF at the L3/4-L5/S1 levels. Demographic variables and clinical features including reported outcome measures, spine sagittal parameters, paraspinal muscle parameters and imaging grading system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Difference analysis was used to compare the differences between groups in demographic variables and clinical features. Linear regression models were used to evaluate the association between spine-specific and generalized sarcopenia and clinical features. Additionally, mediation analysis was employed to explore the role of paraspinal muscles in the pathway through which generalized sarcopenia affects clinical features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The generalized-sarcopenia patients exhibited significantly higher scores for VAS-back (p=.03), VAS-leg (p=.038), ODI (p&lt;.001), SVA (p=.011) and tPfirrmann (p&lt;.001), while significantly lower scores were observed for JOA (p=.001), TK (p&lt;.001), LL (p=.005), and tDHI (p=.002). In the subsequent analysis, 36 of subjects were in the SSGS (spine-specific and generalized sarcopenia) group, 123 were in the NSSNGS (non-spine-specific and nongeneralized sarcopenia) group, 19 were in the NSSGS group and 107 were in the SSNGS group. Compared to the NSSNGS group, the SSGS group exhibited significantly lower JOA scores (p&lt;.001), higher ODI scores (p=.003), reduced TK (p=.005), reduced LL (p=.005), increased SVA (p&lt;.001), and a significantly higher tPfirrmann grading (p=.002). In Multiple linear regression analysis, the NSSNGS group exhibited significantly higher JOA, TK, LL, and tDHI values, with increases of 4.15 (p&lt;.001), 8.87 (p&lt;.001), 14.14 (p&lt;.001), and 0.11 (p=.012) times than SSGS group, respectively, along with significantly lower ODI (B=-11.44, p=.006), SVA (B =-44.96, p&lt;.001), and tPfirrmann grading (B=-2.29, p=.001). The mediation analysis indicated that paraspinal muscles play an important role in the association between generalized sarcopenia and LL (effect size=-1.3","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of lumbar disc degeneration based on interpretable machine learning models: retrospective cohort study.","authors":"Tenghui Li, Weihui Qi, Xinning Mao, Gaoyong Jia, Wei Zhang, Xiaofeng Li, Hao Pan, Dong Wang","doi":"10.1016/j.spinee.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The paraspinal muscles play a critical role in maintaining lumbar spine stability, and different muscles may have varying impacts on lumbar disc degeneration (LDD). However, studies exploring these relationships remain relatively limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to investigate the relationship between various paravertebral muscles and LDD and to develop and validate a predictive model for LDD using machine learning (ML).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A retrospective analysis was performed on hospitalized patients who underwent computed tomography (CT) and magnetic resonance imaging (MRI) examinations for chronic low back pain from February 2018 to January 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome measures included model performance metrics such as receiver operating characteristic (ROC) curves, accuracy, sensitivity, specificity, F1 score, positive predictive value (PPV), negative predictive value (NPV), and calibration curves. Clinical decision-making benefits were assessed using decision curve analysis (DCA). Secondary outcome measures focused on model interpretability, evaluated through SHapley Additive exPlanations (SHAP), which identified key predictors and quantified their contributions to LDD prediction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study enrolled 518 patients as the internal cohort, who were randomly assigned to a training set (70%) and a test set (30%). The Synthetic Minority Oversampling Technique (SMOTE) was applied to mitigate class imbalance in the training set. Model parameters were optimized using grid search and 10-fold cross-validation to develop four machine learning models: Extreme Gradient Boosting (XGBoost), Random Forest (RF), Logistic Regression (LR), and Decision Tree (DT). External validation was performed using data from 343 patients from different tertiary medical centers. Paraspinal muscle parameters on lumbar spine CT and MRI images were measured using ImageJ, and LDD was evaluated based on the Pfirrmann grading system. Spearman correlation analysis and logistic regression were performed to assess factors associated with LDD. Model performance was evaluated using metrics such as ROC curves, accuracy, sensitivity, F1 score, PPV, NPV, calibration curves, and DCA. The SHAP method was employed to interpret the ML models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included a total of 861 patients for analysis. In the external validation cohort, the XGBoost model demonstrated the best performance, achieving an AUC of 0.880 (95% CI: 0.826-0.935). Its accuracy (0.819), specificity (0.841), and positive predictive value (PPV=0.958) outperformed other models. Notably, it also exhibited superior sensitivity (0.814) and F1-score (0.880). SHAP analysis further revealed that age, the psoas muscle index (PMI), and the functional cross-sectional area (fCSA) of the ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal aortic calcification is associated with impaired fusion after elective spinal fusion.","authors":"Marco D Burkhard, Thomas Caffard, Lukas Schönnagel, Samuel Medina, Ali E Guven, Anna-Maria Mielke, Bruno Verna, Erika Chiapparelli, Giuseppe Loggia, Alexander C Gregg, Ranqing Lan, Jennifer Shue, Federico P Girardi, Frank P Cammisa, Andrew A Sama, Alexander P Hughes","doi":"10.1016/j.spinee.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.012","url":null,"abstract":"<p><strong>Background context: </strong>The interplay between vascular compromise and spinal pathology has been underexplored in the context of spinal fusion outcomes. Abdominal aortic calcification (AAC) is associated with various degenerative spinal conditions, potentially due to impaired perfusion. However, the relationship between AAC and the success of osseous fusion mass formation following spinal fusion remains unexplored.</p><p><strong>Objectives: </strong>To investigate the association between AAC severity and fusion success following posterior lumbar spine fusion surgery.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient population: </strong>Patients undergoing open posterior lumbar fusion between 2010 and 2021 at a single institution.</p><p><strong>Outcome measures: </strong>Osseous posterolateral fusion (PLF) and interbody fusion (IBF) on computed tomography.</p><p><strong>Methods: </strong>The institutional database was queried for patients who underwent open posterior spinal fusion and had postoperative CT scans at ≥12 months. Preoperative standing lateral lumbar radiographs were assessed for aortic calcification using the AAC-24 classification, which is a score between 0 (no AAC) to 24 (most severe AAC). Fusion success was evaluated using the Lenke (PLF) and Bridwell (IBF) classifications on CT. Binary outcomes of fusion success versus impairment were created for PLF and IBF and a combined outcome of either PLF and/or IBF for a third analysis. Multivariable logistic regression was used to identify predictors of impaired fusion, including AAC, age, sex, BMI, smoking, diabetes, number of levels fused, and fusion to the sacrum.</p><p><strong>Results: </strong>A total of 207 patients were included for analysis. PLF impairment was observed in 28.5%, and IBF impairment in 22.7%. AAC was an independent predictor of impaired PLF (OR 1.10, 95% CI 1.02-1.20; p=.015) and combined PLF/IBF impairment (OR 1.16, 95% CI 1.06-1.29; p=.002). Multivariable analysis revealed, that each one-point increase in the AAC-24 score increased the odds of combined fusion impairment by 16%, and an increase of one standard deviation was associated with approximately a 2-fold increase in risk. Number of levels fused also predicted combined fusion impairment (OR 1.67, 95% CI 1.15-2.48; p=.009). No significant association was found between AAC and IBF impairment alone.</p><p><strong>Conclusions: </strong>AAC is independently associated with posterolateral fusion impairment following spinal fusion surgery. routine preoperative assessment of AAC on lateral spine radiographs may help identify patients at higher risk for impaired fusion and guide surgical decision-making. Further studies are needed to validate these findings and evaluate strategies to mitigate this risk.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic functional network connectivity remodeling in cervical spondylotic myelopathy: insights into postoperative neural recovery.","authors":"Bingyong Xie, Jiyuan Yao, Haoyu Ni, Zhibin Xu, Sicheng Bian, Haoxiang Wang, Kun Zhu, Peiwen Song, Yuanyuan Wu, Yongqiang Yu, Fulong Dong","doi":"10.1016/j.spinee.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.003","url":null,"abstract":"<p><strong>Background context: </strong>The longitudinal changes in large-scale brain network dynamic functional network connectivity (dFNC) and their role in postoperative recovery remain insufficiently explored.</p><p><strong>Purpose: </strong>To investigate the remodeling of brain dFNC in individuals with cervical spondylotic myelopathy (CSM), focusing on temporal characteristics and their association with neural function recovery.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Patient sample: </strong>The study included 32 CSM patients and 32 age- and sex-matched healthy controls (HCs).</p><p><strong>Outcome measures: </strong>We calculated the dFNC states and their temporal characteristics, and the correlation of these measures with improvements in clinical symptoms were assessed as key outcomes.</p><p><strong>Methods: </strong>Group independent component analysis (GICA) was employed to extract whole-brain independent components (ICs). A sliding time window and k-means clustering were utilized to identify dFNC states. Intergroup differences in connectivity were systematically compared, and correlation analyses were conducted to associate temporal variations in dFNC with clinical recovery outcomes.</p><p><strong>Results: </strong>GICA identified ten functional networks, and dFNC revealed four distinct states. Participants predominantly occupied State 1, indicated by higher mean dwell time and fractional time. Preoperatively, CSM patients showed reduced functional connectivity (FC) in the visual, default mode, and frontoparietal networks. Three months postoperatively, these patients partially regained functional connectivity in some dynamic states. Additionally, changes in fractional time (FT) in State 4 were significantly negatively correlated with improvements in neural function.</p><p><strong>Conclusions: </strong>This study offers a dynamic perspective on the remodeling of large-scale brain networks in patients with CSM following surgery. These findings elucidate the neurobiological mechanisms underlying spinal cord recovery postdecompression and suggest novel therapeutic strategies for postoperative rehabilitation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biceps involvement and degree of motor deficit at diagnosis are independently predictive of timing of postoperative C5 palsy recovery.","authors":"Gregory Toci, Jonathan Dalton, Rachel Huang, Michael Carter, Robert J Oris, Rajkishen Narayanan, Andrew Kim, Julienne Jeong, Brady Stallman, Kenneth McCall, Mark F Kurd, Ian D Kaye, Barrett I Woods, Jeffrey A Rihn, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1016/j.spinee.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.006","url":null,"abstract":"<p><strong>Background context: </strong>C5 palsy is a debilitating complication following cervical spine surgery. This is the largest single-institution study evaluating C5 palsy and is specifically aimed at risk factors predictive of recovery timing.</p><p><strong>Purpose: </strong>To assess the impact of demographic, radiographic, and surgical factors on C5 palsy recovery timing.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Adult patients with postoperative C5 palsy following anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), combined ACDF/PCDF, or laminoplasty between 2010 and 2023.</p><p><strong>Outcome measures: </strong>C5 palsy recovery at 6 months and 1 year after surgery, postoperative opioid consumption, cervical alignment measurements including (1) C2-C7 cobb angle, (2) C2-C7 sagittal vertical axis, (3) C2 slope, (4) C2 tilt, and (5) T1slope.</p><p><strong>Methods: </strong>Demographics, surgical and radiographic variables were recorded. Patients were divided based on resolution of symptoms to the level of their preoperative strength versus persistence of symptoms at 6 months and 1 year after surgery. Appropriate statistical analysis was performed with alpha <0.05.</p><p><strong>Results: </strong>93 patients had postoperative C5 palsy (63-PCDF, 21-ACDF, 6-ACDF/PCDF, 3-laminoplasty). Patients whose C5 palsy persisted at 6 months were more likely to be male, older, and have higher Charlson Comorbidity Index. At 1 year, those with persistent symptoms were demographically similar to those with resolution. Preoperative radiographic variables (C2-C7 Cobb angle and SVA, C2 tilt and slope, and T1 slope) were not associated with recovery timing at either timepoint. Multivariable logistic regression identified biceps involvement at C5 palsy diagnosis as independently predictive of persistence of symptoms at 6 months, and degree of both biceps and deltoid weakness as predictive at both timepoints (6 months: odd ratio=1.92; p=0.005; 1 year: estimate-1.90; p=0.011). 71% of all patients recovered within 1 year.</p><p><strong>Conclusions: </strong>The presence of biceps involvement independently predicted persistence of C5 palsy at 6 months. The severity of biceps and deltoid motor deficit independently predicted persistence of C5 palsy both timepoints. Identifying these risk factors can help to inform patient counseling regarding the recovery dynamics of C5 palsy.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the influence of cage and instrumentation strategies with oblique lumbar interbody fusion for grade I spondylolisthesis - A comprehensive biomechanical modeling study.","authors":"Mathieu Chayer, Philippe Phan, Pierre-Jean Arnoux, Zhi Wang, Jeremy J Rawlinson, Olumide Aruwajoye, Carl-Éric Aubin","doi":"10.1016/j.spinee.2025.04.009","DOIUrl":"10.1016/j.spinee.2025.04.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Proper implant selection and placement in oblique lumbar intervertebral fusion (OLIF) are essential to achieve the best possible results for the patient. Key factors such as interbody cage length, height, angle, and material must all be carefully considered to achieve the intended results and minimize complications. Significant challenges remain in selecting the appropriate cage parameters to control spinal alignment while minimizing subsidence risk. Ongoing debates include how long a cage should be to optimize load distribution, as well as how variations in cage angle and placement influence the outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to biomechanically model and investigate how variations in interbody cage dimensions, positioning, and material properties influence indirect decompression, realignment, and resulting stresses involved in cage subsidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Computational biomechanical study of interbody cage and OLIF influence on correction outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A pathological finite element model of the L4-L5 segment presenting a grade I spondylolisthesis was used to simulate 172 different OLIF configurations, evaluating cage position (anterior, central, posterior), angle (6° or 12°), material (PEEK or titanium), length (40 to 60 mm), and height (10 to 14 mm). Bilateral pedicle screw fixation was also tested. The simulated outcomes included disc height, foraminal and spinal canal dimensions, segmental lordosis, vertebral slip, endplate stresses, and displacements under various loading conditions. Statistical comparisons were tested to analyze the influence of model, implant, and surgical parameters on correction outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Longer (left-to-right dimension) cages (60 mm), which overhang on both sides of the vertebrae and sit on the apophyseal ring, significantly reduced vertebral endplate displacements and stresses by 33% compared to shorter cages (40 mm) (p &lt; 0.05). Posterior cage positioning improved the decompression but raised stresses by 45% and reduced segmental lordosis by 28%. Lowering cage height from 14 to 10 mm and increasing the angle from 6° to 12° reduced endplate stresses by 53% and 33%, respectively. BPS fixation decreased stresses by 36% on average. The trends observed concurred with recently published OLIF clinical studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study highlights the biomechanical influence of implant characteristics and positioning on OLIF results and subsidence risks. Competing factors unveil an optimization problem that can be effectively addressed with the help of accurate, robust, and reproducible numerical simulations and regression models. This study further confirms that the developed tools not only accurately simulate the surgical approach and corroborate clinical findings but also offer a relevant framework for in-depth analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significan","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with future academic faculty appointment after spine surgery fellowship training.","authors":"Jason Silvestre, Sydney Seeger, Robert A Ravinsky, James P Lawrence, James D Kang, Charles A Reitman","doi":"10.1016/j.spinee.2025.04.005","DOIUrl":"10.1016/j.spinee.2025.04.005","url":null,"abstract":"<p><strong>Background context: </strong>Understanding optimal training environments for future academic leaders is a topic of increasing interest in spine surgery.</p><p><strong>Purpose: </strong>This study determined the association between surgeon factors and future academic faculty appointment after spine surgery fellowship training.</p><p><strong>Study design/setting: </strong>This was a retrospective observational study of spine surgery fellows in the United States (2016-2017 to 2022-2023).</p><p><strong>Patient sample: </strong>N/A.</p><p><strong>Outcome measures: </strong>The primary outcome of interest was future academic faculty appointment, which was assigned if the spine surgeon was employed at a teaching hospital. Demographic, bibliometric, and training characteristics of spine surgery fellows were obtained.</p><p><strong>Methods: </strong>Bivariate analyses were performed to determine the association between surgeon factors and future academic faculty appointment.</p><p><strong>Results: </strong>There were 654 spine surgery fellows and 243 were appointed to academic faculty positions (37.2%). There was no difference in the rate of future academic faculty appointment between male and female spine surgeons (36.7% vs. 45.7%, p=.368). Allopathic graduates were more likely to obtain academic faculty positions than osteopathic graduates (40.6% vs. 12.5%, p<.001). Compared to spine surgeons in private practice, spine surgeons in academic practice had more peer-reviewed publications during medical school (1±3 vs. 0±2, p<.001) and orthopedic surgery residency training (5±13 vs. 3±5, p<.001). Several characteristics of spine surgery fellowship programs were associated with future academic faculty appointment including geographic region (p=.013), Accreditation Council for Graduate Medical Education (ACGME) accreditation status (p<.001), and a greater volume of annual fellows (p=.003).</p><p><strong>Conclusions: </strong>Several factors were associated with future academic faculty appointment in spine surgery including higher scholarly output during medical school and orthopedic residency. These data may ultimately help trainees and fellowship selection committees in spine surgery align on desired academic career objectives.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative teriparatide intervention is cost-effective for osteoporotic patients undergoing lumbar fusion: a break-even cost analysis.","authors":"Muhammad Waheed, Dhiraj Patel, Paul Anderson, Rakesh D Patel, Ilyas Aleem","doi":"10.1016/j.spinee.2025.04.007","DOIUrl":"10.1016/j.spinee.2025.04.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar spinal fusion is a common procedure increasingly being performed in older patients many of whom have poor bone quality. Poor bone quality is associated with increased risk of bone related complications and need for revision surgery. Preoperative bone health optimization has been proposed to address this poor bone health using anti-osteoporosis medications. However, there remains ongoing controversy regarding the use of bisphosphonates and teriparatide for osteoporotic patients and few studies have explored the cost-effectiveness of teriparatide in lumbar spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aim of the study is to determine the cost-effectiveness, quantified in terms of absolute risk reduction (ARR) and number needed to treat (NNT), of teriparatide to prevent symptomatic pseudarthrosis following lumbar spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Economic analysis, Level of Evidence 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;The present break-even analysis considers simulated patients with and without osteoporosis undergoing primary posterior lumbar spinal fusion. The analysis is independent of the total number of annual surgeries and can be applied to any sized cohort of patients with osteoporosis undergoing primary posterior lumbar spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;We calculated the final break-even cost rate of pseudoarthrosis, the absolute risk reduction, and the number need to treat to prevent one symptomatic pseudoarthrosis event while breaking even on cost utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The MEDLINE database was queried for prior literature regarding the cost of teriparatide and revision lumbar fusion surgery for symptomatic pseudarthrosis in the United States as well as the rate of symptomatic bony nonunion in osteoporotic patients undergoing spinal fusion. Two break-even cost analyses were performed utilizing the surgical cost alone and the total overall cost to calculate the ARR in pseudarthrosis required to deem teriparatide as cost-effective. The ARR was then used to calculate the number of patients that would require teriparatide, NNT, to prevent one pseudarthrosis event while breaking-even on overall cost expenditure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When observing surgical cost alone, daily-use teriparatide was determined to be positively cost effective at initial rates of pseudarthrosis &gt;53.4% in osteoporotic patients. Utilization of the total overall cost in our break-even model showed daily-use teriparatide to be cost effective when the initial nonunion rate exceeded 30.6%. Teriparatide was not cost-effective at lower initial rates of pseudarthrosis for osteoporotic patients. In both scenarios of investigating total overall cost and surgical cost alone, the ARR decreases as the cost of symptomatic pseudarthrosis treatment rises. At higher costs of revision surgery and higher initial pseudarthrosis rates, teriparatide becom","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}